Symposia
Technology
Courtney Beard, Ph.D.
Psychologist
McLean Hospital
Belmont, Massachusetts
Risa Weisberg, PhD
Professor
Boston University
Boston, Massachusetts
Erin Beckham, BA
Research Assistant
McLean hospital
Belmont, Massachusetts
Ramya Ramadurai, BA
GRaduate student
American University
Washington, District of Columbia
Heather Martin, None
Research Assistant
McLean Hospital
Belmont, Massachusetts
We will describe the delivery of a cognitive bias intervention in two real-world settings. First, given that most people first seek treatment for mental health in primary care, we developed an on-line cognitive bias intervention as a low-intensity treatment for anxiety delivered by undergraduate coaches in the patients’ primary care clinics. Second, given that the month following discharge from psychiatric hospital care is a time of increased risk for relapse and suicide, we developed a transdiagnostic, personalized, smartphone app targeting interpretation bias as an augmentation of a CBT-based acute psychiatric treatment program and extension of treatment during the month post-discharge. We tested this intervention as an augmentation to both an in-person and virtual partial hospital program.
We will present design and delivery considerations for each setting, such as the need for personalization, flexibility, and varying levels of human support. We will also present quantitative and qualitative data from pilot trials suggesting that both interventions were feasible and acceptable. We will discuss challenges to retention and adherence, as well as strategies we employed to enhance engagement. Finally, we will present the 5 patterns of engagement identified during the month following discharge from the hospital. Despite the challenging nature of the post-acute period, most of the sample classified as high use: (1) adherent (35%), (2) super user, (27%) (3) consistently low use, (15%), (4) drop-off, (12%) and (5) high diary use (9%).
Given the lack of behavioral health providers in primary care, low-intensity interventions have the potential to help fill the huge unmet treatment need. In acute psychiatric care, this type of intervention may support patients in implementing CBT-based skills during the challenging transition from hospital to daily life. The current pilot studies suggest that large hybrid effectiveness/implementation RCTs testing these interventions in real-world settings are warranted.